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South Dakota rates for HCPCS 70540

Mri Orbit Face &/Neck W/O Contrast

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$64.98 / $64.98 / $64.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.06 / $475.00 / $522.50
Aetna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$56.56 / $140.00 / $154.00
Aetna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$155.50 / $335.00 / $368.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$440.89 / $539.11 / $673.89
Cigna
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$117.99 / $144.28 / $180.35
Cigna
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$322.89 / $394.83 / $493.54
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$315.68 / $486.68 / $2,821.00
Medica
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$80.61 / $124.32 / $625.77
Medica
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$235.04 / $362.36 / $2,451.15
Midlands
Facility/Professional
Facility
Modifier
26
Low / Median / High Price
$212.38 / $212.38 / $212.38
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$488.88 / $590.41 / $871.00
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.48 / $431.31 / $591.66
Sanford Health Plan
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$81.52 / $107.24 / $122.26
Sanford Health Plan
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$240.19 / $322.16 / $479.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$278.82 / $486.68 / $608.50
United
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$75.48 / $124.32 / $141.06
United
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$203.33 / $362.36 / $474.02
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$511.40 / $601.70 / $601.70
Wellmark
Facility/Professional
Professional
Modifier
26
Low / Median / High Price
$140.69 / $165.50 / $165.50
Wellmark
Facility/Professional
Professional
Modifier
TC
Low / Median / High Price
$370.70 / $436.10 / $436.10